Created
November 15, 2017 17:43
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<!--Begin CTCT Sign-Up Form--> | |
<!-- EFD 1.0.0 [Mon Aug 28 11:09:22 EDT 2017] --> | |
<div class="ctct-embed-signup"> | |
<div> | |
<span id="success_message" style="display:none;"> | |
<div style="text-align:center;"> | |
<h3 class="article--title"> | |
Thank you for taking the next step in healing your arthritis. You should receive your video in your email shortly. | |
</h3> | |
</div> | |
</span> | |
<form data-id="embedded_signup:form" class="ctct-custom-form Form" name="embedded_signup" method="POST" action="https://visitor2.constantcontact.com/api/signup"> | |
<p></p> | |
<!-- The following code must be included to ensure your sign-up form works properly. --> | |
<input data-id="ca:input" type="hidden" name="ca" value="fd342522-1003-4f26-ba37-ae62bf64ef16"> | |
<input data-id="list:input" type="hidden" name="list" value="2091333883"> | |
<input data-id="source:input" type="hidden" name="source" value="EFD"> | |
<input data-id="required:input" type="hidden" name="required" value="list,email,first_name"> | |
<input data-id="url:input" type="hidden" name="url" value=""> | |
<div class="clear mc-field-group"> | |
<p data-id="Email Address:p" > | |
<label data-id="Email Address:label" data-name="email" class="ctct-form-required"></label> <input data-id="Email Address:input" type="text" placeholder="Email Address" name="email" value="" maxlength="80"> | |
</p> | |
</div> | |
<div class="clear mc-field-group"> | |
<p data-id="First Name:p" > | |
<label data-id="First Name:label" data-name="first_name" class="ctct-form-required"></label> <input data-id="First Name:input" type="text" name="first_name" placeholder="First Name" value="" maxlength="50"> | |
</p> | |
</div> | |
<div class="clear mc-field-group"> | |
<button type="submit" class="Button js-btn button ctct-button Button--block Button-secondary" data-enabled="enabled">Send Me The Free Video!</button> | |
</div> | |
<!-- | |
<p class="ctct-form-footer">By submitting this form, you are granting: Blum Center for Health, 34 Rye Ridge Plaza, Rye Brook, New York, 10573, United States, http://www.blumcenterforhealth.compermission to email you. You may unsubscribe via the link found at the bottom of every email. (See our <a href="http://www.constantcontact.com/legal/privacy-statement" target="_blank">Email Privacy Policy</a> for details.) Emails are serviced by Constant Contact.</p> | |
--> | |
</form> | |
</div> | |
</div> | |
<script type='text/javascript'> | |
var localizedErrMap = {}; | |
localizedErrMap['required'] = 'This field is required.'; | |
localizedErrMap['ca'] = 'An unexpected error occurred while attempting to send email.'; | |
localizedErrMap['email'] = 'Please enter your email address in name@email.com format.'; | |
localizedErrMap['birthday'] = 'Please enter birthday in MM/DD format.'; | |
localizedErrMap['anniversary'] = 'Please enter anniversary in MM/DD/YYYY format.'; | |
localizedErrMap['custom_date'] = 'Please enter this date in MM/DD/YYYY format.'; | |
localizedErrMap['list'] = 'Please select at least one email list.'; | |
localizedErrMap['generic'] = 'This field is invalid.'; | |
localizedErrMap['shared'] = 'Sorry, we could not complete your sign-up. Please contact us to resolve this.'; | |
localizedErrMap['state_mismatch'] = 'Mismatched State/Province and Country.'; | |
localizedErrMap['state_province'] = 'Select a state/province'; | |
localizedErrMap['selectcountry'] = 'Select a country'; | |
var postURL = 'https://visitor2.constantcontact.com/api/signup'; | |
</script> | |
<script type='text/javascript' src='https://static.ctctcdn.com/h/contacts-embedded-signup-assets/1.0.2/js/signup-form.js'></script> | |
<!--End CTCT Sign-Up Form--> |
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